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1.
Strahlenther Onkol ; 200(5): 409-417, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38153435

RESUMO

BACKGROUND: The mainstay treatment of nasopharyngeal cancer (NPC) is radiation therapy (RT). The doses and volumes may differ from center to center. Most studies and guidelines recommend a total dose of 60 Gy for elective nodal and peritumoral volume treatment. This retrospective analysis aimed to analyze whether a dose reduction to 54 Gy to this volume would be associated with a higher risk of recurrence. METHODS: A total of 111 patients treated by intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy were retrospectively analyzed. The recurrent tumor volume was classified as "in field" if 95% of the recurrent volume was inside the 95% isodose, as "marginal" if 20-95% of the recurrence was inside the 95% isodose, or as "outside" if less than 20% of the recurrence was inside the 95% isodose. RESULTS: Median follow-up was 67 months (range 6-142). The 2­ and 5­year overall survival (OS) rates were 88.6% and 70%, respectively. The 2­year locoregional control (LRC), disease-free survival (DFS), and distant metastasis-free survival (DMFS) were 93.3%, 89.3%, and 87.4%, and the 5­year LRC, DFS, and DMFS were 86.8%, 74%, and 81.1%, respectively. Ten patients (9%) had a local and or regional recurrence. Half of the patients with locoregional failure had in-field recurrences. For primary tumor, there was no recurrence in the volume of 54 Gy. For regional lymph node volume, recurrence was detected in two (1.8%) patients in the volume of 54 Gy. CONCLUSION: These retrospective data suggest that a dose reduction may be possible for intermediate-risk volumes, especially for the primary site.


Assuntos
Quimiorradioterapia , Neoplasias Nasofaríngeas , Recidiva Local de Neoplasia , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada , Humanos , Masculino , Neoplasias Nasofaríngeas/radioterapia , Neoplasias Nasofaríngeas/patologia , Neoplasias Nasofaríngeas/mortalidade , Neoplasias Nasofaríngeas/terapia , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , Estudos Retrospectivos , Adulto Jovem , Taxa de Sobrevida , Carga Tumoral , Intervalo Livre de Doença , Adolescente , Estadiamento de Neoplasias , Seguimentos
2.
Strahlenther Onkol ; 198(11): 1025-1031, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36074137

RESUMO

PURPOSE: We aimed to investigate the appropriate postoperative radiotherapy dose and selective volume in T3-4 N0 laryngeal cancer patients treated with either total or partial laryngectomy. METHODS: Patients who received radiotherapy for locally advanced (T3-T4) and pathologic node-negative (N0) squamous cell laryngeal cancer were retrospectively evaluated. Radiotherapy was applied to median 60 Gy (range 54-60 Gy) as selective local radiotherapy (±stoma). The local treatment areas included postoperative bed + laryngeal area for patients with a partial laryngectomy, and the postoperative bed only for patients with total laryngectomy. RESULTS: The median follow-up time was 59 months and 52 patients were included. The 2­year, 5­year, and 8­year locoregional recurrence controls (LRC) were 95.6%. The 2­year and 5­year OS rates were 93.8% and 78.9%, respectively. The 5­year OS for age < 60 years was 95.8%, for above 60 years 56.5%. CONCLUSION: Our data suggest that local selective irradiation to the postoperative bed + stoma is enough in patients with T3-4 N0 laryngeal cancer without applying elective nodal irradiation.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Laríngeas , Humanos , Pessoa de Meia-Idade , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/cirurgia , Neoplasias Laríngeas/patologia , Estudos Retrospectivos , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/patologia , Recidiva Local de Neoplasia/patologia , Laringectomia , Estadiamento de Neoplasias
3.
Support Care Cancer ; 27(1): 239-247, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29938330

RESUMO

PURPOSE: Patients with head and neck cancers are susceptible to malnutrition during radiotherapy. This study aimed to determine the changes in the nutritional status and its determinants in patients with head and neck cancer during radiotherapy. METHODS: This prospective observational study was performed in an outpatient Radiation Oncology clinic with a sample of 54 patients. An interview form (including anthropometric and laboratory parameters), the Patient-Generated Subjective Global Assessment to assess nutritional status, quality of life scales, and toxicity criteria were used for data collection at the baseline, the end of radiotherapy and 1 and 3 months after radiotherapy. RESULTS: While the majority of the patients (90%) were well nourished at baseline, most of the patients (74%) were malnourished at the end of radiotherapy (p < 0.001). During radiotherapy, patients developed malnutrition, reflected in a decrease in food intake, approximately 5% loss of body weight, a reduction in mid-arm upper circumference and mid-arm muscle mass, and reduced serum protein and albumin levels. The nutritional status was worse in oropharyngeal cancers (p = 0.021), advanced stage (p = 0.004), use of concomitant chemotherapy (p = 0.041), and worse toxicity (p < 0.001). Furthermore, the nutritional status was strongly associated with the quality of life. CONCLUSIONS: This study demonstrated negative impact of radiotherapy on the nutritional status of patients with head and neck cancer. The study also showed the association of the nutritional status and the quality of life. The nutritional status should be assessed during different periods in the trajectory of treatment due to its significant contribution to the quality of life.


Assuntos
Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/radioterapia , Estado Nutricional/fisiologia , Qualidade de Vida , Adulto , Idoso , Peso Corporal , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/metabolismo , Humanos , Entrevistas como Assunto , Estudos Longitudinais , Masculino , Desnutrição/epidemiologia , Desnutrição/etiologia , Pessoa de Meia-Idade , Lesões por Radiação/epidemiologia , Adulto Jovem
4.
J Neurooncol ; 118(2): 413-419, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24668610

RESUMO

To test the hypothesis on prolonged survival in glioblastoma cases with increased subventricular zone (SVZ) radiation dose. Sixty glioblastoma cases were previously treated with adjuvant radiotherapy and Temozolamide. Ipsilateral, contralateral and bilateral SVZs were contoured and their doses were retrospectively evaluated. Median follow-up, progression free survival (PFS) and overall survival (OS) were 24.5, 8.5 and 19.3 months respectively. Log-rank tests showed a statistically significant correlation between contralateral SVZ (cSVZ) dose > 59.2 Gy (75th percentile) and poor median PFS (10.37 [95% CI 8.37-13.53] vs 7.1 [95% CI 3.5-8.97] months, p = 0.009). cSVZ dose > 59.2 Gy was associated with poor OS in the subgroup with subtotal resection/biopsy (HR: 4.83 [95% CI 1.71-13.97], p = 0.004). High ipsilateral SVZ dose of > 62.25 Gy (75th percentile) was associated with poor PFS in both subgroups of high performance status (HR: 2.58 [95% CI 1.03-6.05], p = 0.044) and SVZ without tumoral contact (HR: 10.57 [95% CI 2.04-49], p = 0.008). The effect of high cSVZ dose on PFS lost its statistical significance in multivariate Cox regression analysis. We report contradictory results compared to previous publications. Changing the clinical practice based on retrospective studies which even do not indicate consistent results among each other will be dangerous. We need carefully designed prospective randomized studies to evaluate any impact of radiation to SVZ in glioblastoma.


Assuntos
Neoplasias Encefálicas/terapia , Quimiorradioterapia , Glioblastoma/terapia , Ventrículos Laterais/efeitos da radiação , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos Alquilantes/uso terapêutico , Dacarbazina/análogos & derivados , Dacarbazina/uso terapêutico , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Ventrículos Laterais/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Dosagem Radioterapêutica , Radioterapia Adjuvante , Temozolomida , Resultado do Tratamento , Adulto Jovem
5.
J BUON ; 19(4): 953-7, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25536601

RESUMO

PURPOSE: To evaluate the performance of volumetric arc therapy (VMAT), dynamic intensity modulated radiotherapy (IMRT) and step-and-shoot IMRT techniques in nasopharyngeal cancer (NPC) patients. METHODS: IMRT plans of 48 NPC patients treated between May 2010 and December 2012, were evaluated. Twenty two patients were planned with VMAT, 18 with dynamic IMRT and 8 with step-and-shoot IMRT. Conformity index (CI) and homogeneity index (HI), the dosimetry of the planning target volumes (PTVs) and organs at risk (OARs) and the monitor units (MU) were evaluated for each IMRT modality. RESULTS: The conformity indices of VMAT and dynamic IMRT were better than step-and-shoot IMRT plans (p<0.05). Step-and-shoot IMRT plans provided better homogeneity than VMAT (p=0.01). MUs for dynamic IMRT were much higher compared to VMAT (p<0.01) and step and- shoot IMRT (p<0.01). There was no significant difference between the 3 techniques in terms of PTV70 mean doses. When compared with step-and-shoot IMRT, VMAT and dynamic IMRT had a better sparing effect on optic nerves, eyes and optic chiasm (p<0.05). VMAT plans performed better sparing for brain stem than dynamic IMRT (p=0.01). There was a remarkable decrease in the maximum doses of VMAT to the eye. CONCLUSIONS: VMAT outperforms dynamic IMRT by effectively reducing the MU and the dose to some OARs, with adequate PTV coverage. Also, VMAT provides better sparing of normal tissue and conformity than step-and-shoot IMRT. Differences between step-and-shoot IMRT and dynamic IMRT are thought to be due to technical differences of linear accelerator devices like fiber size, variable fiber, dose rate and gantry.


Assuntos
Neoplasias Nasofaríngeas/radioterapia , Radioterapia de Intensidade Modulada , Humanos , Radiometria , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador
6.
Am J Clin Oncol ; 47(6): 279-288, 2024 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-38390915

RESUMO

OBJECTIVES: This study aims to examine the treatment outcomes and related factors in locally advanced sinonasal cancer across Turkiye. METHODS: Twelve centers participants of the Turkish Society for Radiation Oncology Head and Neck Study Group attended the study. One hundred and ninety-four patients treated with intensity-modulated radiation therapy between 2001 and 2021 were analyzed retrospectively. The survival analysis was performed using the Kaplan-Meier method. Acute and late toxicity were recorded per Common Toxicity Criteria for Adverse Events V4.0. RESULTS: The median age was 58 years and 70% were male. The majority of tumors were located in maxillary sinus (59%). Most of the patients (%83) had T3 and T4A disease. Fifty-three percent of patients were in stage 4A. Radiotherapy was administered to 80% of the patients in the adjuvant settings. Median 66 Gy dose was administered in median 31 fractions. Chemotherapy was administered concomitantly with radiotherapy in 45% of the patients mostly with weekly cisplatin. No grade ≥4 acute and late toxicity was observed. The median follow-up was 43 months. The 5-year and 10-year overall survival (OS); locoregional recurrence-free survival (LRFS); distant metastasis-free survival (DMFS), and progression-free survival (PFS) rates were 61% and 47%; 69% and 61%; 72%, and 69%, and 56% and 49%, respectively. In the multivariate analysis, several factors demonstrated significant influence on OS, such as performance status, surgery, and lymph node involvement. Moreover, surgery was the key prognostic factor for LRFS. For DMFS, lymph node involvement and surgical margin were found to be influential factors. In addition, performance status and lymph node involvement were identified as significantly affecting PFS. CONCLUSIONS: In our study, the authors obtained promising results with IMRT. Performance status, lymph node involvement, and surgery emerged as the primary factors significantly influencing OS.


Assuntos
Neoplasias dos Seios Paranasais , Radioterapia de Intensidade Modulada , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Estudos Retrospectivos , Neoplasias dos Seios Paranasais/radioterapia , Neoplasias dos Seios Paranasais/patologia , Neoplasias dos Seios Paranasais/mortalidade , Turquia , Idoso , Adulto , Radioterapia de Intensidade Modulada/métodos , Taxa de Sobrevida , Idoso de 80 Anos ou mais , Resultado do Tratamento , Radioterapia (Especialidade)
7.
Tumour Biol ; 34(6): 3363-9, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23754449

RESUMO

The primary aim of this study is to assess differences in patients' clinicopathological characteristics based on human papillomavirus (HPV) status and the effect of HPV status on outcome in oropharyngeal squamous cell carcinoma (OSCC). The medical registry of 81 patients who were treated for OSCC was retrospectively analyzed. Factors that are found to be predictive of poor overall survival and event risk by univariate Cox's regression analysis included age greater than 60 years (hazard ratio (HR), 1.2, p = 0.02, and HR, 1.12, p = 0.05), poor Eastern Cooperative Oncology Group performance (HR,1.6, p = 0.01, and HR,1.32, p = 0.001), advanced T stage (HR,1.38, p = 0.01, and HR,1.4, p = 0.02), advanced N stage(HR, 1.6, p = 0.03, and HR,1.5, p = 0.03), smoking history (HR,1.4, p = 0.04, and HR, 1.6, p = 0.03), and HPV-negative patients (HR, 2.4, p = 0.012, and HR, 1.8, p = 0.01). HPV-positive tumors were estimated to have a 36 % reduction in risk of death and 32% reduction in event risk. HPV status had independent prognostic effects on survival and event-free survival.


Assuntos
Carcinoma de Células Escamosas/complicações , Neoplasias Orofaríngeas/complicações , Papillomaviridae/genética , Infecções por Papillomavirus/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Neoplasias Orofaríngeas/patologia , Papillomaviridae/classificação , Infecções por Papillomavirus/virologia , Reação em Cadeia da Polimerase , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco/estatística & dados numéricos , Fatores de Risco
8.
Sci Rep ; 13(1): 10384, 2023 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-37369756

RESUMO

Stereotactic ablative body radiation therapy (SBRT) has emerged as the standard treatment for inoperable patients with stage I non-small cell lung cancer (NSCLC). In the current study, we retrospectively analyzed a medically operable patient cohort with stage I NSCLC who refused surgery and subsequently underwent SBRT. Overall survival (OS) and progression-free survival (PFS) were calculated. Between April 2014 and July 2020, 55 patients were enrolled to the study. Forty (72.7%) patients were male, with a mean age of 69.85 ± 4.65 years (range 59-78 years). ECOG performance status were 0 and 1, except for one case. At the time of analysis, 8 deaths were observed. Of these, 25% (n = 2) died due to cardiac events, 12.5% (n = 1) due to pulmonary causes, 12.5% (n = 1) due to lung cancer-related causes, and the cause of death was unknown for 50% (n = 4). The pulmonary causes and cardiac events were not associated with radiation-induced toxicity. The median survival time was 34 months, with a range of 12 to 44 months. 2-year OS and PFS were 97% and 98%, 3-year OS and PFS were 82% and 77%, respectively. Treatment with SBRT was well tolerated and no grade 3 and 4 treatment-related adverse events were observed. SBRT seems to be a well- tolerated and effective alternative for patients with operable early-stage NSCLC.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Doenças Cardiovasculares , Neoplasias Pulmonares , Lesões por Radiação , Radiocirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Feminino , Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias Pulmonares/patologia , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Estadiamento de Neoplasias , Lesões por Radiação/etiologia , Doenças Cardiovasculares/etiologia
9.
Photodiagnosis Photodyn Ther ; 38: 102887, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35490961

RESUMO

BACKGROUND: Radiation-induced optic neuropathy (RION) is one of the most important late complications during head and neck radiotherapy and is recognized usually between 2-9 years after RT. Our study aims to prospectively without baseline measurement evaluate retinal and optic disc vascular changes and retinal nerve fiber layer thickness (RNFL) using optical coherence tomography angiography (OCTA) in nasopharyngeal cancer (NPC) patients previously treated with intensity-modulated radiation therapy (IMRT) and with optic nerve doses are above 45 Gy. METHODS: Fourteen NPC patients and sixteen age-matched healthy control subjects were included in our study. A complete ophthalmological examination including the best-corrected visual acuity (BCVA), intraocular pressure, slit-lamp biomicroscopic, fundoscopic examination and OCTA were performed for all patients and healthy volunteers. OCTA findings of RT and control groups were compared and correlation analysis was performed to find the association between the radiation-related factors and OCTA findings. RESULTS: Inferior hemi disc, parafovea and perifovea superficial/deep vessel densities were were statistically significantly lower in RT patients. Negative correlations were found between Dmax of optic tract and both RNFL and vessel densities. Furthermore, there were negative correlations found between the Dmean of glob and vessel densities. CONCLUSION: Although none of the patients in our study had marked vision loss and retinal abnormalities with the examination, OCTA findings showed that perifoveal and parafoveal vascularity were statistically significantly affected due to the RT.


Assuntos
Neoplasias Nasofaríngeas , Disco Óptico , Fotoquimioterapia , Radioterapia de Intensidade Modulada , Angiofluoresceinografia/métodos , Humanos , Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/radioterapia , Fibras Nervosas , Disco Óptico/irrigação sanguínea , Fotoquimioterapia/métodos , Radioterapia de Intensidade Modulada/efeitos adversos , Vasos Retinianos/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos
10.
Turk J Pediatr ; 64(2): 285-292, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35611417

RESUMO

BACKGROUND: Retinoblastoma shows high rates of recurrence after initial chemotherapy (systemic or intraarterial). Our aim was to evaluate the effectiveness of iodine-125 radioactive plaque brachytherapy as a salvage treatment with globe-preserving attributes after initial chemotherapy in patients with intraocular retinoblastoma. METHODS: The effect of brachytherapy was investigated retrospectively in 17 eyes of 17 patients who were followed up due to retinoblastoma between May 2012 and June 2018 and who received iodine-125 radioactive plaque brachytherapy as a salvage treatment after systemic or intra-arterial chemotherapy. The regression, ocular toxicity, and enucleation rates were evaluated at the end of the follow-up period. RESULTS: The tumor locations were post equator, macular, anterior to the equator, and peripapillary in 5, 3, 7, and 2 patients, respectively. Regression was initially and rapidly observed in 17 of the 17 eyes that underwent brachytherapy. Enucleation was performed in 5 (29.42%) of these patients due to recurrence with diffuse tumor involvement, and 4 of the tumors were located anterior to the equator. In 12 (70.58%) patients, the eyes were protected from enucleation following local brachytherapy. CONCLUSIONS: Radioactive plaque brachytherapy can be applied as an effective salvage therapy with successful results in retinoblastoma patients who have received initial systemic or intra-arterial chemotherapy. Post equator-located solitary tumors have the highest success rate.


Assuntos
Braquiterapia , Neoplasias da Retina , Retinoblastoma , Humanos , Lactente , Radioisótopos do Iodo , Neoplasias da Retina/tratamento farmacológico , Neoplasias da Retina/radioterapia , Retinoblastoma/tratamento farmacológico , Retinoblastoma/radioterapia , Estudos Retrospectivos , Terapia de Salvação , Resultado do Tratamento
11.
Front Oncol ; 10: 1447, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32974165

RESUMO

Purpose and Objective: To evaluate the disease-free survival, overall survival, dosimetric, and voice handicap index (VHI) results of T1a glottic invasive squamous cell carcinoma (SCC) patients who underwent hypofractionated single vocal cord irradiation (HSVCI). Materials and Methods: The data of 18 patients with stage T1a glottic SCC were collected prospectively and analyzed retrospectively between July 2016 and July 2019. Patients were immobilized using a custom-fitted thermoplastic face and shoulder mask in hyperextension position. The CT scan was performed with 1-mm-thick slices. A planned target volume (PTV) margin of 3 mm was given to clinical target volume (CTV) in all directions, and 13 organs at risk were identified. Patients were prescribed a total of 5760-5808 cGy in 15-16 fractions. Patients had daily cone-beam computed tomography (CBCT), and the treatment was carried out with the physician. VHI test was applied to patients before and at the end of radiotherapy (RT) and 1, 2, 3, 4, and 6 months after the completion of RT. Results: Local control and overall survival rate is 100% for a median of 18 months (6-44 months) of follow-up. A patient was diagnosed with 2nd primary lung cancer and active treatment still continues. All patients completed the treatment within the scheduled time. Grade 1-2 dysphagia and dermatitis occurred in all patients, and no grade 3 and above side effects were observed. The mean values of VHI were 37.00, 39.83, 38.28, 17.17, 12.22, 8.56, and 6.06 at the beginning of RT, at the end of RT, and 1, 2, 3, 4, and 6 months after RT, respectively. Conclusion: Compared to surgery and conventional laryngeal radiotherapy, HSVCI is an alternative treatment method for T1a glottic cancer by reducing the treatment time to 3 weeks, facilitating recurrence treatment, and providing effective sound quality without compromising local control. Considering that ~80% of recurrences in glottic cancer occur within the first 2 years, 100% local control in a median of 18 months is extremely successful, but long-term follow-up is essential to observe possible late side effects.

12.
Sisli Etfal Hastan Tip Bul ; 53(4): 353-360, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-32377108

RESUMO

Lung cancer is divided into two subgroups concerning its natural course and treatment strategies as follows: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). In this review, for NSCLC, the role of stereotactic body radiation therapy (SBRT) in early-stage, chemoradiation in the locally advanced stage, post-operative radiotherapy for patients with high risk after surgery and radiotherapy for metastatic disease will be discussed. Also, for SCLC, the role and timing of thoracic irradiation and prophylactic cranial irradiation (PCI) for the limited and extensive stages will be discussed.

13.
Radiother Oncol ; 129(3): 527-533, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30172456

RESUMO

PURPOSE: To report the feasibility, accuracy, and reliability of volumetric modulated arc therapy (VMAT)-based total-body irradiation (TBI) treatment in patients with acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL). MATERIALS AND METHODS: From 2015 to 2018, 30 patients with AML or ALL were planned and treated with VMAT-based TBI, which consisted of three isocenters and three overlapping arcs. TBI dose was prescribed to 90% of the planning treatment volume (PTV) receiving 12 Gy in six fractions, at two fractions per day. Mean lung and kidney doses were restricted less than 10 Gy, and maximum lens dose less than 6 Gy. Quality assurance (QA) comprised the verification of the irradiation plans via dose-volume histogram (DVH) based 3D patient QA system. RESULTS: Average mean lung dose was 9.7 ±â€¯0.2 Gy, mean kidney dose 9.6 ±â€¯0.2 Gy, maximum lens dose 4.5 ±â€¯0.4 Gy, mean PTV dose 12.7 ±â€¯0.1 Gy, and heterogeneity index of PTV was 1.16 ±â€¯0.02 in all patients. Grade 3 or more acute radiation toxicity was not observed. When comparing plan and DVH-based 3D patient QA results, average differences of 3.3% ±â€¯1.3 in mean kidney doses, 1.1% ±â€¯0.7 in mean lung doses, and 0.9% ±â€¯0.4 in mean target doses were observed. CONCLUSION: Linac-based VMAT increased the dose homogeneity of TBI treatment more than extended SSD techniques. Partial cone-beam CT and optical surface-guided system assure patient positioning. DVH-based 3D patient dose verification QA was possible with linac-based VMAT showing small differences between planned and delivered doses. It is feasible, accurate, and reliable.


Assuntos
Leucemia Mieloide Aguda/radioterapia , Leucemia-Linfoma Linfoblástico de Células Precursoras/radioterapia , Radioterapia de Intensidade Modulada/métodos , Irradiação Corporal Total/métodos , Adolescente , Adulto , Criança , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceleradores de Partículas , Garantia da Qualidade dos Cuidados de Saúde , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/métodos , Reprodutibilidade dos Testes , Adulto Jovem
14.
Radiother Oncol ; 81(1): 39-46, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16965827

RESUMO

PURPOSE: This Rare Cancer Network (RCN) study was performed in pediatric nasopharyngeal carcinoma (PNPC) patients to evaluate the optimal dose of radiotherapy and to determine prognostic factors. PATIENTS AND METHODS: The study included 165 patients with the diagnosis of PNPC treated between 1978 and 2003. The median age was 14 years. There were 3 (1.8%) patients with stage I, 1 (0.6%) with IIA, 10 (6.1%) with IIB, 60 (36.4%) with III, 44 (26.7%) with IVA, and 47 (29%) with IVB disease. While 21 (12.7%) patients were treated with radiotherapy (RT) alone, 144 (87.3%) received chemotherapy and RT. The median follow-up time was 48 months. RESULTS: The actuarial 5-year overall survival (OS) was 77.4% (95% CI: 70.06-84.72), whereas the actuarial 5-year disease-free survival (DFS) rate was 68.8% (95% CI: 61.33-76.31). In multivariate analysis, unfavorable factors were age >14 years for LRC (p=0.04); male gender for DMFS (p=0.03); T3/T4 disease for LRFS (p=0.01); and N3 disease for DFS (p=0.002) and OS (p=0.002); EBRT dose of less than 66 Gy for LRFS (p=0.02) and LRRFS (p=0.0028); and patients treated with RT alone for LRFS (p=0.0001), LRRFS (p=0.007) and DFS (p=0.02). CONCLUSION: Our results support the current practice of using combined radiation and chemotherapy for optimal treatment of NPC. However, research should be encouraged in an attempt to reduce the potential for long-term sequelae in pediatric patients given their relatively favorable prognosis and potential for longevity.


Assuntos
Neoplasias Nasofaríngeas/radioterapia , Doenças Raras/radioterapia , Adolescente , Fatores Etários , Criança , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Intervalo Livre de Doença , Fracionamento da Dose de Radiação , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Neoplasias Nasofaríngeas/tratamento farmacológico , Neoplasias Nasofaríngeas/mortalidade , Recidiva Local de Neoplasia , Prognóstico , Doenças Raras/tratamento farmacológico , Doenças Raras/mortalidade , Fatores Sexuais , Resultado do Tratamento
15.
Kulak Burun Bogaz Ihtis Derg ; 26(3): 176-80, 2016.
Artigo em Turco | MEDLINE | ID: mdl-27107606

RESUMO

Acantholytic squamous cell carcinoma is an uncommon variant of squamous cell carcinoma. Acantholytic squamous cell carcinoma occurs in the sun-exposed areas of the skin and lip. It is rarely observed in the respiratory and digestive tract and may present more aggressively. The incidence of distant metastases of squamous cell head and neck cancers is low and the lungs are the most common metastatic sites. Metastasis to the soft tissue, skin, and adrenal glands from the laryngeal region is very uncommon. In this article, we report a 58-year-old female case who underwent postoperative radiation therapy with the diagnosis of acantholytic squamous cell carcinoma of the larynx and developed metastasis to the soft tissue and adrenal gland at the early period.


Assuntos
Carcinoma de Células Escamosas/patologia , Neoplasias Laríngeas/patologia , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/cirurgia , Pessoa de Meia-Idade , Metástase Neoplásica
16.
Int J Radiat Oncol Biol Phys ; 63(5): 1347-53, 2005 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-16169671

RESUMO

PURPOSE: The current study reports on long-term quality of life (QoL) status after conventional radiotherapy in 187 nasopharyngeal carcinoma patients from 14 centers in Turkey. PATIENTS AND METHODS: Patients with the diagnosis of nasopharyngeal carcinoma, who were treated in 14 centers in Turkey with minimum 6 months of follow-up and were in complete remission, were asked to complete Turkish versions of EORTC QLQ-C30 questionnaire and the HN-35 module. Each center participated with the required clinical data that included age at diagnosis, gender, symptoms on admission, follow-up period, treatment modalities, radiotherapy dose, and AJCC 1997 tumor stage. Each patient's 33 QoL scores, which included function, global health status, and symptoms, were calculated as instructed in EORTC QLQ-C30 scoring manual. All of the scales and single-item measures range from 0 to 100. A high score represents a higher response level. Kruskal-Wallis and Mann-Whitney U nonparametric tests were used for comparisons. RESULTS: One hundred eighty-seven patients with median age of 46 years (range, 16-79 years) participated and completed the questionnaires. Median follow-up time was 3.4 years (range, 6 months-24 years). All patients have received external-beam radiotherapy. Beside external-beam radiotherapy, 59 patients underwent brachytherapy boost, 70 patients received concomitant chemotherapy, and 95 patients received adjuvant/neoadjuvant chemotherapy. Most of the patients in the analysis (75%) were in advanced stage (Stage III, n = 85 [45.4%]; Stage IV, n = 55 [29%]). Mean global health status was calculated as 73. Parameters that increased global health status were male gender, early-stage disease, and less than 4-year follow-up (p < 0.05). Functional parameters were better in males and in early-stage disease. Factors that yielded better symptom scores were short interval after treatment (10 scores), male gender (7 scores), and lower radiation dose (6 scores). Neoadjuvant or adjuvant chemotherapy did not have any effect on QoL, whereas concomitant chemotherapy adversely affected 5 symptom scores. CONCLUSION: Quality of life is adversely affected in our nasopharyngeal carcinoma patients treated with combined therapies. The factors that adversely affect quality of life are advanced tumor stage, female gender, and long-term follow-up. Further controlled studies to evaluate both preradiotherapy and postradiotherapy status are necessary to clarify the contribution of each treatment modality to QoL.


Assuntos
Neoplasias Nasofaríngeas/radioterapia , Qualidade de Vida , Inquéritos e Questionários , Adolescente , Adulto , Idoso , Quimioterapia Adjuvante , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Nasofaríngeas/tratamento farmacológico , Neoplasias Nasofaríngeas/patologia , Fatores Sexuais , Estatísticas não Paramétricas , Turquia
17.
Asian Pac J Cancer Prev ; 16(5): 1897-900, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25773841

RESUMO

PURPOSE: To evaluate acute toxicity in nasopharyngeal cancer (NPC) patients treated with intensity modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT) with or without cisplatin-based chemotherapy. MATERIALS AND METHODS: A total of 45 newly diagnosed, histologically proven non-metastatic NPC patients treated with IMRT between May 2010 and December 2012, were evaluated retrospectively, 37 planned with Eclipse and 8 with Prowess Panther treatment planning system. The doses to the planning target volumes of primary tumor and involved lymph nodes, high risk region, and uninvolved regional nodal areas were 70 Gy, 60 Gy, and 54 Gy respectively and delivered simultaneously over 33 fractions to 39 patients. Another 6 patients irradiated with sequential boost technique. Some 84.4% of patients received chemotherapy. Acute toxicities were graded according to the Radiation Therapy Oncology Group scoring criteria and Common Terminology Criteria for Adverse Events (CTCAE) for chemotherapy side effects. RESULTS: Median age was 43 years (14-79) and all patients were WHO type II. Grade 1 mucositis and dysphagia were observed in 17 (37.8%), and 10 (22.2%) patients, respectively. The incidence of acute grade 2 mucositis and dysphagia was 55.6% and 68.9%, respectively. The most common chemoradiotherapy related acute toxicities were nausea, leucopenia and thrombocytopenia. Grade 3 toxicity was detected in 13 (28.8%) cases. No grade 4 toxicity was occurred. Mean weight loss was 9%. None of the patients required the insertion of percutaneous endoscopic gastrostomy for nutritional support. Radiation therapy was completed without interruption in all patients. CONCLUSIONS: IMRT is a safe and effective treatment modality, and well tolerated by patients in the treatment of nasopharyngeal carcinoma. No unexpected side effects were observed.


Assuntos
Neoplasias Nasofaríngeas/radioterapia , Radioterapia de Intensidade Modulada/efeitos adversos , Adolescente , Adulto , Idoso , Antineoplásicos/uso terapêutico , Carcinoma , Quimiorradioterapia , Cisplatino/uso terapêutico , Terapia Combinada , Transtornos de Deglutição/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosite/epidemiologia , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas/tratamento farmacológico , Neoplasias Nasofaríngeas/patologia , Náusea/epidemiologia , Lesões por Radiação/patologia , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Estudos Retrospectivos , Trombocitopenia/epidemiologia , Adulto Jovem
18.
Int J Radiat Oncol Biol Phys ; 54(3): 855-60, 2002 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-12377339

RESUMO

PURPOSE: To investigate the treatment outcome and prognostic factors of adult medulloblastoma patients who received postoperative craniospinal irradiation (RT). METHODS AND MATERIALS: Between 1983 and 2000, 30 adult patients (17 men and 13 women, age >or=16 years, median 27, range 16-45) underwent postoperative RT. The median duration of symptoms was 2 months (range 1-9). The tumor location was lateral in 16 (53%). A desmoplastic variant was seen in 12 (40%). Tumor resection was complete in 20 (67%) and incomplete in 10 (33%). All patients received craniospinal RT. The median dose to the whole brain was 40 Gy (range 36-51), to the posterior fossa 54 Gy (range 49-56), and to the spinal axis 36 Gy (range 24-40). The median interval between surgery and the start of RT was 31 days (range 12-69), and the median duration of RT was 45 days (range 34-89). Ten patients (33%) received adjuvant chemotherapy. The median follow-up was 51 months (range 5-215). RESULTS: The 5- and 8-year overall survival and disease-free survival rates were 65% and 51% and 63% and 50%, respectively. Twelve patients (40%) developed relapse, with a median follow-up of 51 months. The posterior fossa was the most common site of relapse (6 patients). The median time to relapse was 26 months (range 4-78). Fifty percent of the relapses occurred after 2 years, 17% after 5 years. In univariate analysis, M stage and the interval between surgery and the start of RT were significant prognostic factors for disease-free survival. At 5 years, 70% of M0 patients were estimated to be disease-free, but none of the 3 M3 patients reached 5 years without recurrence (p = 0.0002). The 5-year disease-free survival rate for the patients whose interval between surgery and the start of RT was <3 weeks, between 3 and 6 weeks, and >6 weeks was 0%, 85%, and 75%, respectively (p = 0.002). The 5-year posterior fossa control rate for patients who received >or=54 Gy or <54 Gy to the posterior fossa was 91% and 33%, respectively (p = 0.05). CONCLUSION: The survival results for medulloblastomas in adults compare favorably with those in children. However, late relapses, lateral tumor location, and desmoplastic histologic features are more frequent in adults. Spinal seeding at presentation is a poor prognostic factor for disease-free survival. A minimal dose of 54 Gy to the posterior fossa is essential for adequate tumor control. The interval between surgery and the start of RT, which was found to be a significant prognostic factor, is an interesting issue that requires further study.


Assuntos
Neoplasias Cerebelares/radioterapia , Irradiação Craniana , Meduloblastoma/radioterapia , Coluna Vertebral , Adolescente , Adulto , Análise de Variância , Neoplasias Cerebelares/mortalidade , Neoplasias Cerebelares/cirurgia , Feminino , Humanos , Masculino , Meduloblastoma/mortalidade , Meduloblastoma/cirurgia , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Prognóstico , Dosagem Radioterapêutica , Recidiva , Resultado do Tratamento
19.
Int J Radiat Oncol Biol Phys ; 60(2): 388-94, 2004 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-15380570

RESUMO

PURPOSE: To analyze the results and evaluate the prognostic factors in the retreatment of locally recurrent nasopharyngeal carcinoma. METHODS AND MATERIALS: Forty-one patients with locally recurrent nasopharyngeal carcinoma, who were reirradiated between 1979 and 2000, were retrospectively analyzed. There were 32 men and 9 women with median age of 46 years. Histologically, 9 tumors (22%) were World Health Organization (WHO) I, 17 (41.5%) WHO II, and 15 (36.5%) WHO III. According to the 1998 TNM staging system of the American Joint Committee on Cancer, the recurrent disease was Stage I in 5 (12.2%), Stage II in 11 (26.8%), Stage III in 6 (14.6%), and Stage IV in 19 (46.4%) patients. Treatment was delivered with 4-6 MV X-rays or Co-60 gamma rays. The median reirradiation dose was 50 Gy. Treatment was delivered at 1.8-2 Gy/fraction daily, 5 days a week. Chemotherapy was used in 41.5% of the patients. RESULTS: Median follow-up was 23 months (range, 3-143 months). The 2-year and 5-year local progression-free and overall survival rates were 39%, 23%, 48%, and 28%, respectively. On univariate analysis, age (p = 0.04), total reirradiation dose (p = 0.0008) were significant prognostic factors for local progression-free rate. For overall survival age, total reirradiation dose, stage, T stage were significant. On multivariate analysis only total dose (p = 0.005) remained significant for local progression-free rate and total reirradiation dose (p = 0.02), interval to recurrence (p = 0.03), stage (p = 0.018) were significant for overall survival. CONCLUSIONS: Early diagnosis of local recurrence and high-dose reirradiation (60 Gy) are crucial for improving the local control and survival.


Assuntos
Carcinoma/radioterapia , Neoplasias Nasofaríngeas/radioterapia , Recidiva Local de Neoplasia/radioterapia , Adolescente , Adulto , Idoso , Análise de Variância , Carcinoma/patologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/radioterapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Nasofaríngeas/patologia , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Prognóstico , Modelos de Riscos Proporcionais , Lesões por Radiação/etiologia , Dosagem Radioterapêutica , Indução de Remissão , Estudos Retrospectivos
20.
Asian Pac J Cancer Prev ; 14(8): 4847-51, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24083757

RESUMO

OBJECTIVES: To evaluate accuracy of FDG-PET CT in prediction of persistent disease in head and neck cancer cases and to determine prognostic value of metabolic tumor response. MATERIALS AND METHODS: Between 2009 and 2011, 46 patients with squamous cell carcinoma of head and neck receiving PET-CT were treated with definitive radiotherapy, with or without chemotherapy. There were 29 nasopharyngeal, 11 hypopharyngeal, 3 oropharyngeal and 3 laryngeal cancer patients, with a median age of 50.5 years (range 16-84), 32 males and 14 females. All patients were evaluated with PET-CT median 3-5 months (2.4-9.4) after completion of radiotherapy. RESULTS: After a median 20 months of follow up, complete metabolic response was observed in 63% of patients. Suspicious residual uptake was present in 10.9% and residual metabolic uptake in 26.0% of patients. The overall sensitivity, specificity, positive predictive value and negative predictive value of FDG-PET-CT for detection of residual disease was 91% and 81%, 64% and 96% respectively. Two year LRC was 95% in complete responders while it was 34% in non-complete responders. CONCLUSIONS: FDG PET CT is a valuable tool for assessment of treatment response, especially in patients at high risk of local recurrence, and also as an indicator of prognosis. Definitely more precise criteria are required for assessment of response, there being no clear cut uptake value indicating residual disease. Futhermore, repair processes of normal tissue may consume glucose which appear as increased uptake in control FDG PET CT.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Fluordesoxiglucose F18 , Neoplasias de Cabeça e Pescoço/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Neoplasia Residual/diagnóstico , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/radioterapia , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/radioterapia , Estadiamento de Neoplasias , Neoplasia Residual/radioterapia , Prognóstico , Taxa de Sobrevida , Adulto Jovem
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